seminar on primary care in trauma

1. PRIMARY CARE IN TRAUMA
DR. JEFF ZACHARIA
POST GRADUATE STUDENT
ORAL & MAXILLOFACIAL SURGERY
AJ INSTITUTE OF DENTAL SCIENCES

2. CONTENTS
• Introduction
• Primary survey
• Airway
• Breathing
• Circulation & hemorrhage control
• Disability
• Exposure

3. • Secondary survey
• Head & skull examination
• Oral & Maxillofacial examination
• Neck examination
• Chest examination
• Abdomen examination
• Pelvis examination
• Back examination
• Mass casualty setup
• Conclusion

4. INTRODUCTION
• The initial assessment & management of a patient’s injuries must be completed in an
accurate & systematic manner to establish the extent of any injury to vital life support
systems.
• Nearly 25 – 33 % of deaths caused by injury can be prevented when an organized &
systematic approach is used.

5. • Death from trauma has a trimodal distribution
 Platinum 10 minutes
• Based on the concept that seriously injured patients should have no more than 10 minutes of scene-
time stabilization by first responders prior to transport for definitive care at a trauma center.
• This is the densest time interval at the scene of the accident, the interval that decides the percentage
of “avoidable deaths” in trauma

6. PRE HOSPITAL TRAUMA CARE
Prehospital care of patients is situation-dependent and centered on stabilization of the
patient and prompt transport to a hospital
It includes low-threshold interventions by emergency personnel such as
• Placement of a cervical collar
• Intubation or oxygen delivery via nasal cannula.
• Administration of intravenous fluid (if hemorrhage or hypotension is suspected)
• Administration of analgesia
• Placement of tourniquets or pressure bandages to control bleeding

7. PRIMARY SURVEY

8. PRIMARY SURVEY
• The initial assessment is designed to help the Emergency Medical Responder detect all
immediate threats to life.
• Immediate life threats typically involve the patients ABCs, and each is corrected as it is found.

9. AIRWAY

10. AIRWAY
• Airway assessment and restoration of ventilation are critical first steps in management
of a trauma patient.
• Maintenance of airway is dependent on:
1. The absence of any anatomical or mechanical barrier
2. Preservation of the laryngeal reflex.
3. The existence of adequate pulmonary ventilation.
4. The integrity of the respiratory centre.

11. CAUSES OF RESPIRATORY OBSTRUCTIONS RELATED
TO MAXILLOFACIAL TRAUMA
• Inhalation of blood clot, vomitus, saliva, thick mucous or
portions of teeth, bone & dentures.
• Inability to protrude the tongue because of posterior
displacement of the anterior fragment of the mandible
(B/L parasymphysis fracture)
• Occlusion of the oropharynx by the soft palate after
retro-position of the maxilla

12. Signs & Symptoms of respiratory distress
• Restlessness, apprehension, anxiety
• Tachypnoea, tachycardia, pallor
• Decreasing ventilatory excursions
• Declining peripheral hypotension
• Cyanosis (may be present with Hb > 5g)

13. NON SURGICAL AIRWAY MAINTENANCE
• Position of the patient: Supine with neck extended sideways or patient can be made prone with head
down so collection of blood or saliva in the mouth is not aspirated.
• Oropharyngeal toilet: all blood, saliva, thick mucus or foreign bodies should be cleared from the oral
cavity by digital exploration or by cotton swabs if available.
• Suction
• Anterior traction of tongue.

14. • Chin lift is done by placing the thumb underneath the
chin and lifting forward.
• Jaw thrust is done by placing the long fingers behind
the angle of the mandible and pushing anteriorly and
superiorly although, jaw thrust is preferred if cervical
spine injury is suspected.

15. MECHANICAL AIRWAY ADJUNCTS
Oropharyngeal Airway
• It prevents the tongue from obstructing the glottis, and also
provides an air channel and suction conduit through the mouth.
• It is contraindicated in patients with a gag reflex as it can stimulate
retching, vomiting, or laryngospasm.

16. Nasopharyngeal Airway
• Commonly used with intoxicated or semiconscious victims. They are
also effective when trauma, trismus (i.e., clenched teeth), or other
obstacles (e.g., wiring of the teeth) preclude OPA placement.
• NPAs are contraindicated in victims with basilar skull or facial
fractures, because inadvertent intracranial placement may occur.

17. SURGICAL AIRWAY MAINTENANCE
Indications of tracheostomy
• Airway obstruction above the level of the trachea.
• Need for prolonged intubation.
• More efficient pulmonary hygiene.
• Inability to intubate.
• Adjunct to major head & neck surgery.

18. How to perform tracheostomy?
1. Incision
2. Dissection

19. 3. Airway entry
4. Tube stabilization

20. Perioperative complications
• Pneumothorax
• Bleeding
• False passage into the mediastinum.
• Interstitial edema
• Damage to laryngeal nerve
• Tracheoesophageal fistula
Post operative complications
• Hemorrhage
• Aspiration
• Infection
• Tube displacement
• Hypoxia
• Tracheal stenosis
• Voice changes
• scarring

21. PERCUTANEOUS TRANSTRACHEAL VENTILATION
• It provides a temporary airway until a formal surgical airway can
be supplied in children younger than 12 years of age where
cricothyrotomy is contraindicated because of the anatomic
difficulty in performing the procedure and risk of stenosis.
• Through this method, alveolar oxygen concentrations can be
maintained for up to 30 to 45 minutes.

22. CRICOTHYROIDOTOMY
Cricothyroidotomy is useful in emergency situations
when attempts to ventilate by bag-valve-mask and
ET tube are unsuccessful.
 Indications
• Inability to intubate
• Inability to ventilate
• Inability to maintain SpO2 >90%
• Severe traumatic injury that prevents oral or nasal
tracheal intubation
Contraindications
• Inability to identify landmarks: underlying anatomical
abnormality such as a tumor or severe goiter
• Tracheal transection
• Acute laryngeal disease due to infection or trauma
• Small children under 12 years old

23. 1. Immobilize the larynx and palpate the cricothyroid membrane
2. Vertical incision of the skin & horizontal incision of the CTM
Procedure

24. 3. Insert finger through incision into trachea 4. Tracheal tube insertion
5. Securing the tube

25. C SPINE CONTROL
• Assume cervical spine injury in patients with multisystem
trauma.
• In suspected cases, patient’s head and neck should not be
hyper extended or hyper flexed.
• Intubations performed with the complete cervical collar in
place are associated with greater spinal subluxation

26. CARDINAL SIGNS OF C SPINE INJURY
1. Flaccid extremities
2. Diaphragmatic breathing
3. Ability to flex forearms but unable to extend
4. Facial grimace in response to pain above the clavicle and not below it.
5. Hypotension with warm extremities.
6. Priapism

27. LOG ROLLING TECHNIQUE

28. BREATHING

29. BREATHING
Signs of respiratory distress
• Anxiety
• Tachypnoea more than 25/min.
• Stridor
• Intercostal retraction
• Use of accessory muscles for respiration.
• Hoarseness of voice
• Pallor
• Tachycardia
• Increase in BP
• Signs of hypoxia, hypercapnia, cyanosis

30. TRAUMATIC PNEUMOTHORAX
• Pneumothorax occurs when air enters the in to the
pleural space.
• Air can find its way into the pleural space when there’s
an open injury in the chest wall or a tear or rupture in
the lung tissue, disrupting the pressure that keeps the
lungs inflated.

31. Symptoms of pneumothorax
• Chest ache
• Dyspnea
• Cold sweat
• Chest tightness
• Cyanosis
• Severe tachycardia
Diagnosis of pneumothorax
• PA chest
• CT scan
• Thoracic USG
Normal CXR Pneumothorax CXR

32. TRAUMATIC HEMOTHORAX
• It refers to collection of blood between the pleural
space
• Traumatic hemothorax often causes the pleural
membrane lining the lungs to rupture causing it to spill
blood into the pleural space.
• Hemothorax often occurs with pneumothorax.

33. Symptoms of hemothorax
• Chest ache
• Cold clammy skin
• Tachycardia
• Low BP
• Shallow breathing
• anxiety
Diagnosis of hemothorax
• PA chest
• CT scan
• Thoracic USG

34. FLAIL CHEST
• Flail chest is an injury that occurs typically
following a blunt trauma to the chest.
• When three or more ribs in a row have multiple
fractures within each rib, it can cause a part of
the chest wall to become separated and out of
sync from the rest of the chest wall.

35. Mechanism
• blunt forces
• deceleration injuries
Associated Injuries
• scapula fractures
• clavicle fractures
• hemo/pneumothorax
Signs & Symptoms
• pain
• respiratory difficulty
• hemopneumothorax
• paradoxical respiration
• chest wall deformity
• bony or soft-tissue crepitus

36. Imaging
• Radiographs
• CT
Treatment
• Observation is advised when there is no respiratory
compromise or when then there is not more than 3
fractured segments.
• ORIF is advised when there is respiratory compromise, open
rib fractures or when there is more than 3 flail segments of
the ribs

37. MANAGEMENT OF BREATHING
• If not breathing adequately, begin BAG-VALVE-MASK-VENTILATION
• If breathing fast or hypoxia, administer Oxygen to achieve oxygen saturations between 94-
98%.
• If wheezing, administer 5mg salbutamol IV
• If concern for tension pneumothorax, perform NEEDLE DECOMPRESSION and plan for chest
tube insertion

38. CIRCULATION

39. CIRCULATION & HEMORRHAGE CONTROL
• Once the airway and breathing are stabilized, perform an initial evaluation of the patient's
circulatory status by palpating central pulses. If a carotid or femoral pulse is verified and no
obvious exsanguinating external injury is present, circulation may momentarily be assumed to
be intact.
• In almost all medical and surgical emergencies, consider hypovolemia to be the primary cause
of shock, until proven otherwise.

40. ASSESSMENT OF CIRCULATION
Pulse
• Absent or diminished peripheral pulse is a sign of shock
• Tachycardia - is a sign of shock, as well as of fear and anxiety.
• Bradycardia - is a sign of imminent death.
Capillary Refill
• A prolonged CRT suggests poor peripheral perfusion.
• Capillary refill is prolonged in shock, but is also prolonged by pain, fever and environmental
factors, such as cold.

41. Skin color/temperature
• Mottling/pallor and cyanosis of the skin indicate poor perfusion due to either a
sympathetic response to low cardiac output or to pain, fear or cold.
Blood Pressure
• Hypotension is a late sign of shock, and imminent death.

42. Other signs of circulatory inadequacy
• Respiratory distress or failure
• Agitation, confusion or decreased conscious level
• Rapid, deep breathing may be a sign of metabolic acidosis
• Decreased urinary output.

43. CARDIOPULMONARY RESUSCITATION
If the health care provider is unable to feel the carotid pulse in 10 seconds, the
provider should begin chest compressions and rescue breaths.

44. • CPR involves chest compressions at least 5cms (2 inches) deep
at the rate of at least 100 per minute in an effort to create
artificial circulation by manually pumping blood through heart.
• In addition , the rescuer may provide breathe by either
exhaling into patient’s mouth or nose or utilizing a device
thatpushes air into subject’s lungs (artificialventilation)

45. Universal compression : Ventilation ratio
• For adults 30 : 2 recommended
• For children 15 : 2 recommended
Recommended depth of compression
• In Adults and children 5 cm (2 inches)
• In Infants 4 cm (1.5 inches)
Hand placement
• In Adults rescuer should use both hands
• In Children they should use one hand.
• In infants 2 fingers (index and middle finger)

46. HYPOVOLEMIC SHOCK
• Shock has been defined as a state of acute energy failure that stems from a
decrease in adenosine triphosphate production, and subsequent failure to meet the
metabolic demands of the body leading to anaerobic metabolism and cytotoxic
metabolite accumulation
• It is the most common type of shock seen in trauma patients and occurs as a result
of decreased intravascular volume secondary to acute blood loss.

47. Pathophysiology of shock
Deprivation of O2
Anaerobic metabolism
Accumulation of lactic acid (metabolic acidosis)
When glucose is exhausted (anaerobic also stops)
Failure of Na/K pumps
Activates the intracellular lysosomes
Which activates release of autodigestive enzymes
Cell lysis

48. CLASSIFICATION OF HAEMORRHAGIC SHOCK BY THE ‘AMERICAN
COLLEGE OF SURGEONS COMMITTEE ON TRAUMA’
Class I: Acute blood loss < 15% of total blood
volume
• Pulse and respirations increase
• BP may not be significantly affected
Class II: Acute blood loss 20-25% of total blood
volume
• Increased pulse & respirations
• Decreased blood pressure
• No change in urine output
Class III: Blood loss of 30-40% of total blood volume
◦ Increased pulse and respirations
◦ Decreased blood pressure
◦ Decreased urine output
Class IV: Blood loss of 40-50% of total blood volume
◦ Lack of vital signs
◦ Poor mental status

49. MANAGEMENT OF SHOCK
Fluid replacement
• Initial resuscitation should consist of bolus of 2 L of warmed crystalloid solution. 2-3 times of blood
volume lost must be replaced with crystalloids.
• After initial resuscitation, colloids are preferred as these restore intravascular volume. 1 – 1.5 times
blood lost can be replaced with colloids.
• Blood transfusion: if Hb < 8. If massive transfusion is required [>10 units of packed red blood cell
(PRBCs)], attempts should be made at maintaining a 1:1 ratio of PRBCs and FFP

50. • Supportive care: nasal oxygenation and ventilator support will be necessary.
• Catheterization has to be done to measure urine output (30 – 50 mL/hr. or 0.5 mL/kg/hour should be
maintained)
• Correction of acid base balance by administration of 8.4% Sodium bicarbonate IV (normal S. lactate
levels: 0.5 – 1 mmol/L )
• Administration of 500 – 1000 mg hydrocortisone to improve perfusion, reduce capillary leakage and
systemic inflammatory effects.
• Administration of IV morphine 4mg for pain control.
• Use of activated C protein to prevent the release of inflammatory mediators
• Hemodialysis maybe necessary when kidneys are not functioning

51. LOCAL METHODS TO CONTROL BLEEDING
• local pressure (biting on gauze or tea bags)
• site packing [gelatin sponges (Gelfoam); absorbable oxycellulose (Surgicel);
microcrystalline collagen (Avitene)]
• additional suturing
• electrocautery
• topical thrombin powder
• tranexamic acid mouth rinse 5%
• cold water rinse
• aminocaproic acid mouth rinse 5% (hold 10ml in mouth for 2 minutes an
hour pre-procedure then repeat q2h for 6-10 doses prn)

52. ANTERIOR NASAL PACKING
• Epistaxis is defined as acute hemorrhage from the nostril, nasal
cavity, or nasopharynx.
• Nasal packing is done if the bleeding cannot be controlled even after
application of pressure on the nostrils.
• Packing is done using ribbon gauze soaked with liquid paraffin.
• It can be done either in vertical or horizontal layers.
• vasoconstriction can be attempted with topical application of 4
percent cocaine solution or an oxymetazoline or phenylephrine
solution

53. POSTERIOR NASAL PACKING
• Posterior bleeding is much less common than anterior bleeding
Steps in packing
1. After adequate anesthesia has been obtained, a catheter is passed through the affected
nostril and through the nasopharynx, and drawn out the mouth with the aid of ring forceps

54. 2. A gauze pack is secured to the end of the catheter using umbilical tape or suture material,
with long tails left to protrude from the mouth.
3. The gauze pack is guided through the mouth and around the soft palate using a combination of careful
traction on the catheter and pushing with a gloved finger

55. 4. The gauze pack should come to rest in the posterior nasal cavity. It is secured in position by
maintaining tension on the catheter with a padded clamp or firm gauze roll placed anterior to
the nostril. The ties protruding from the mouth, which will be used to remove the pack, are
taped to the patient’s cheek.

56. DISABILITY

57. DISABILITY
• After the establishment of the airway & stabilization of the cardiovascular system,
neurological examination is done to assess the level of consciousness
• To assess the patient’s level of consciousness, the Glasgow Coma Scale ( Teasdale &
Jennett, 1974) can be used.

58. GLASGOW COMA SCALE

59. A V P U SCALE
• A - ALERT. The alert patient is will be awake, responsive, oriented, and talking
• V - VERBAL. This is a patient who appears to be unresponsive at first, but will
respond to a loud verbal stimulus.
• P - PAINFUL. If the patient does not respond to verbal stimuli, he may respond
to painful stimuli such a sternal (breastbone) rub or a gentle pinch to the shoulder
• U - UNRESPONSIVE. If the patient does not respond to either painful or
verbal stimuli

60. SIMPLIFIED MOTOR SCORE (SMS)
Simplifies assessment of head trauma patients compared to the GCS.
The Simplified Motor Score (SMS) is defined as:
• Obeys commands = 2
• Localizes to pain = 1
• Withdrawals to pain or worse = 0.
Patients with a SMS of <2 indicates significant traumatic brain injury and prompt
evaluation of the head using CT scans should be done.

61. GRADY COMA SCALE
• GRADE I: Patient is slightly confused
• GRADE II: Patient requires a light pain stimulus for appropriate arousal
• GRADE III: Patient is comatose but will ward off deep painful stimulus such as sternal
pressure or nipple twist.
• GRADE IV: Patient reacts inappropriately with either decorticate or decerebrate posturing
to deep painful stimuli.
• GRADE V: Patient remains flaccid when similarly stimulated.

62. INJURY SEVERITY SCORE
• Based on anatomic criteria
• It considers 9 variables
• Each variable has a score from 0 – 6
• It is calculated against a total score of 75
• If the score > 15: mortality of 10 %
ISS score = (sum of 3 highest variables)2
= A2 + B2 + C2

63. PUPILLARY LIGHT REFLEX
• The pupillary light reflex is elicited by shining a bright light into the eye.
This triggers a complex neural reflex that normally leads to pupillary
constriction in both the ipsilateral eye (direct response) and the
contralateral eye (consensual response)
• When an intracranial hematoma expands, the medial edge of the uncus is
pushed over the lateral edge of the tentorium and the ipsilateral third
nerve is compressed, compromising the efferent parasympathetic
pathways to the pupil and resulting in dilation & unresponsiveness to a
light stimuli.

64. EXPOSURE

65. EXPOSURE
• Remove all clothing to halt progression of burn from
melted synthetic compounds or chemicals and to assess
the full extent of body surface involvement in the initial
examination. Irrigate injuries with water or saline to
remove harmful residues.
• Avoid hypothermia by limiting exposure of the body, and
by warming all ongoing fluids.

66. SECONDARY SURVEY

67. SECONDARY SURVEY
It does not begin until the primary survey & resuscitative efforts are completed & well
established.
It involves
• Head to toe evaluation
• history & physical examination
• Reassessment of all vital signs

68. TOTAL PATIENT EVALUATION
Physical examination:
• Head & skull
• Oral & Maxillofacial
• Neck
• Chest
• Abdomen
• Perineum/rectum/vagina
• Musculoskeletal
History:

69. HEAD & SKULL

70. HEAD & SKULL EXAMINATION
• Examine & palpate the head for scalp hematoma, skull
depression, or lacerations.
• No nasogastric tube (NG) should be inserted if there is facial
trauma or evidence of basilar skull fracture.
• Ears should be evaluated for hemotympanum or retro-auricular
ecchymosis (Battle's sign)
• Presence of blood or clear drainage from the ear canal indicates
basilar skull fracture with cerebrospinal (CSF) leak.

71. ORAL & MAXILLOFACIAL

72. ORAL & MAXILLOFACIAL EXAMINATION
Extraoral examination
• The length, breadth & depth of the soft tissue wound should be measured
and documented.
• Inspect the nose & ear for presence of bleeding or CSF leak
• Periorbital edema & ecchymosis , subconjunctival hemorrhage can be
noticed.
• If the patient is conscious, the vision is tested in each eye by asking the
patient to follow the clinician’s finger with eyes, without moving his head.

73. SYSTEMATIC EXAMINATION OF MAXILLOFACIAL INJURIES

74. NEUROLOGICAL EXAMINATION
Facial nerve
• If conscious, we can ask the patient to use the muscles of facial expression.
• If unconscious, nerve stimulators can be used.
Infraorbital nerve
• This nerve may be injured as a result of blow out fractures that involve the
inferior orbital fissure.
Olfactory nerve
• Occurs as a result of fracture of the mid – face that involves the cribriform plate
of the ethmoid.
• Anosmia resulting from this is usually permanent.

75. Oculomotor nerve
• presence of dilated pupil usually occurs from intracranial compression due
to increasing intracranial pressure.
Abducent nerve
• Common in patients who suffered deceleration injuries.
• Results in lateral rectus muscle dysfunction on lateral gaze.
Optic nerve
• The patient can present with pain, loss of vision, visual field loss, loss of
color vision.
• Early identification may salvage the patients vision

76. Intraoral examination
• Oral & Pharyngeal tissues should evaluated for lacerations &
penetrating injuries.
• Orifices of Stenson’s duct & Wharton’s duct must be evaluated
for patency & salivary flow.
• Sublingual hematoma is the most common indicative of
mandibular fracture.
• Antero-posterior laceration & ecchymosis of the palate
indicates palatal fracture

77. • Bilateral condylar fractures are often characterized by
limited mouth opening, anterior open bite & preauricular
pain.
• After 48 hours, pain, swelling & induration may be
indicative of infection associated with mandibular
fractures .
• Reduced mouth opening < 35 mm or deviation of 6 mm
indicates presence of a mechanical problem secondary to
mandibular fractures

78. NEUROLOGICAL EXAMINATION
Inferior alveolar nerve
• May result in lip anesthesia on the affected side which could be permanent.
Lingual nerve
• Less common to be injured.
• Results in anesthesia or paresthesia of the anterior two thirds of tongue.
• If chorda tympani is also damaged, it can result in altered taste sensation

79. RADIOGRAPHS IN MAXILLOFACIAL TRAUMA
For middle third of face
• 15⁰ to 30⁰ occipitomental view
• PA view (Walter’s position)
• Lateral skull view
• Cranial PA view

80. For ZMC fracture
• Occipitomenton view 15⁰ & 30⁰
• PA view ( Walter’s position)
• Submentovertex view
• CT of the orbit
For mandible
• OPG
• Lateral oblique view
• PA view
• Towne’s view for condylar fractures
• Occlusal view

81. NECK EXAMINATION
Inspect for
• tracheal deviation
• subcutaneous emphysema
• laryngeal tenderness
• distension of the neck veins
• carotid pulsation and the presence of a hematoma
Palpate for
• Posterior cervical spine for tenderness along the midline or paraspinal tissues

82. GENERAL PHYSICAL EXAMINATION

83. CHEST EXAMINATION
Inspect for
• bruising (from seat-belts)
• asymmetric or paradoxical chest wall movement
• penetrating wounds
Palpate for
• clavicular and rib tenderness
Auscultate for
• the lung fields
• heart sounds.

84. ABDOMEN EXAMINATION
Inspect for
• Seat-belt bruising / handle-bar injuries
• Distension
• Blood at the urinary meatus / introitus
Palpate for
• Tenderness over the liver, spleen, kidneys and bladder
auscultate for
• Bowel sounds.

85. PELVIS EXAMINATION
Inspect for
• grazes & bruising over the iliac crest
• scrotal, labial or perineal hematoma,
swelling or ecchymosis
• External rotation of one or both extremities
• Limb length discrepancy

86. BACK EXAMINATION
• Can be done during log rolling
Inspect the entire length of the back and buttocks.
Palpate for
• the spine for tenderness
• the scapulae and sacroiliac joints for tenderness

87. MASS CASUALTY

88. TRIAGE
• In mass casualty situations, triage is used to decide who is
most urgently in need of care and whose injuries are less
severe and can wait.
• It is mainly used in natural disasters, major accidents, terrorist
attacks or wars
• It involves a color coding scheme using red, yellow, green,
white, and black tags.

89. RED TAG - (IMMEDIATE)
Used to label those who cannot survive without immediate treatment but who have a
chance of survival.
• Obstructed airway
• SPO2 < 80 % & RR > 35 or < 8 cycles
• HR > 130 bpm
• BP < 80 mmHg
• GCS < 8

90. YELLOW TAGS - (60 MINUTES)
Patient’s condition is stable and are not in immediate danger of death.
• SPO2: 90 – 94 % & RR: 25 – 35 cycles
• HR: 110 – 130 bpm or less than 50 bpm
• GCS: 14
Who will need medical care at some point, after more critical injuries have been treated
• SPO2 > 95%
• HR: 50 – 110 bpm
• GCS: 15
GREEN TAG - (180 MINUTES)

91. ADJUNCTS TO PRIMARY SURVEY & RESUSCITATION
 Diagnostic studies:
• Chest
• Pelvis
• C spine
• USG FAST
 Urinary or gastric catheters
Monitoring
• ABG analysis & ventilatory rate
• End tidal carbon dioxide
• EKG
• Pulse oximetry
• Blood pressure

92. FOCUSED ASSESSMENT WITH SONOGRAPHY IN
TRAUMA (FAST)
It is a rapid bedside ultrasound examination performed as a screening test for blood
around the heart or abdominal organs (hemoperitoneum) after trauma.
It is rapid, sensitive & cost effective and eliminates unwanted CTs.
The four classic areas that are examined for free fluid are the
• perihepatic space
• perisplenic space
• pericardium
• Pelvis

93. CONCLUSION
Trauma care is governed by two underlying principles: early definitive management and
a continuum of treatment from the time of injury to the return to the activities of daily
life. Despite considerable advances in treatment in the last 20 years, trauma continues
to be the main cause of disability and death for people under the age of 40 years.
Therefore, A comprehensive approach addressing the factors before, during and after
the event is essential to improve the quality of life.

94. THANK YOU